June 23--The Republican Senate's health care reform effort debuted Thursday, with four GOP senators saying they'd oppose the plan unless it is changed, but Idaho's lawmakers not among them.

State health care advocates labeled the Senate plan as heartless, the same way the House bill passed last month was received.

Sen. Mike Crapo, in a detailed statement, cited provisions in the Senate proposal that he said would protect coverage for people with pre-existing conditions and allow adult children to stay on their parents' health plans. Both provisions are part of the 2010 Affordable Care Act the Senate plan seeks to replace; the Senate proposal gives states more leeway for determining which treatments for pre-existing conditions will be covered.

Crapo said the plan's proposed cuts to Medicaid and provisions for greater state input on determining health programs and coverage would put Medicaid "on a sustainable fiscal path" and allow more Idahoans to get care.

Under Obamacare, states could expand Medicaid to cover a gap group of adults who earned too much to qualify for regular Medicaid but too little to be eligible for subsidized health insurance. Idaho was one of 19 states that never did. The Senate GOP plan would phase out Medicaid expansion and cap future Medicaid funding, but at the same time provide a different program of subsidizing care with lower income requirements that could help that gap group obtain insurance -- albeit with reduced levels of coverage.

Finally, Crapo said, the Senate's plan to eliminate "burdensome" individual and employer mandates for coverage would help stabilize the insurance market. Critics say eliminating the mandates, which help fund the subsidies, will make health care much less affordable, especially for the poor, the elderly and the sick. Both the House and Senate bills eliminate them.

Crapo said he would await the Congressional Budget Office's analysis of the plan, expected next week, but called it "a promising step toward maintaining affordable care."

Crapo's Senate colleague, Sen. Jim Risch, said it was too early to offer a comment. In the House, Rep. Raúl Labrador's office said he was reviewing the Senate plan. A spokeswoman for Rep. Mike Simpson said Friday the congressman would review a Senate-approved plan "extensively before making a final decision." The latest bill will go to the House if it wins passage in the Senate.

Both Labrador and Simpson voted last month for the House health care bill. Simpson later told a health care summit in Boise that he would not have voted for the plan if he believed it would be enacted into law without changes. The House and Senate proposals are largely similar.

For that reason, the Senate plan Thursday got the same round of rejections from local health advocates as did its House counterpart, with critics noting its impacts on the poor and the elderly, on children, and on rural residents.

Cutting tax credits and Medicaid and curtailing other protections "takes our health care system backwards," said Lauren Necochea, director of Idaho Voices for Children. She said the coverage changes for low-income and disabled children would cut funding for items such as eyeglasses, dental care and special education programs.

The Close the Gap Idaho group called on Risch and Crapo to reject the bill. It said the Senate proposal makes even deeper cuts to Medicaid than the House plan, leaves those with pre-existing conditions vulnerable to policy changes at the state level, and increases premiums and deductibles for people who purchase insurance on the individual marketplace.

Leading Democrats in the Idaho Legislature issued a joint statement calling the proposal "catastrophic" to Idaho's rural and poor populations. Based on the CBO analysis of the House proposal, they said, 130,000 Idahoans could lose coverage among 23 million nationwide.

Note: This story was updated Friday, June 23, 2017, to add Rep. Mike Simpson's comments regarding the Senate bill.